Micropulse diode treatment in refractory neovascular glaucoma, high-energy level combined with adjunctive Ranibizumab

Abstract

Introduction: Neovascular glaucoma is one of the highly refractory glaucoma types that mandates frequent modification of treatment. Micropulse diode cyclophotocoagulation may be a good option, but it may need an adjunctive and modification of parameters away from standard protocol. Design: A prospective, cohort, interventional case study. Purpose: To assess the safety and efficacy of high energy level of micropulse (MP) diode laser application after intravitreal injection of ranibizumab in the treatment of neovascular glaucoma refractory to medical treatment. Patients and Methods: This is a prospective, interventional, cohort, randomized case series study that included patients with neovascular glaucoma refractory to medical treatment. All patients underwent intravitreal injection of ranibizumab and then MP diode transscleral cyclophotocoagulation treatment in a high energy level. All patients were followed up for 24 months. The primary outcome measure was IOP reduction; the secondary outcome measure was stability and number of retreatment sessions; and the third outcome measure was complications. Results: This study included 50 eyes of 50 patients, 52% of them were male while 48% were female. Age of the studied patients ranged between 42 and 74 years with a mean of 60.8 ± 7.6 years. Cause of neovascular glaucoma was diabetes in 31 (62%), RVO in 8 (16%), and ocular ischemic syndrome in 3 (6%) of cases. The mean preoperative IOP was 41.2 ± 5.8 mmHg that decreased to 17.62 ± 2.01, 19 ± 4.05, 18.16 ± 1.96, 18.38 ± 1.96, 18.12 ± 1.98, and 18.3 ± 2.18 mmHg at 1, 3, 6, 12, 18, and 24 months, respectively (P < 0.001). Antiglaucoma treatment significantly decreased from 3.00 to 2.00 (P < 0.001). Success was achieved in 44 (88%) cases, whereas failure was met in 6 (12%) cases. Qualified success was met in 43 (97.2%) succeeded cases, whereas 1 (2.8%) succeeded case was signed under complete success. No major complications were encountered and none of the patients lost vision. Conclusion: Micropulse diode cyclophotocoagulation in high energy level can be a safe and effective noninvasive line of treatment in patients with neovascular glaucoma that may last for up to 24 months. Adjunctive use of intravitreal ranibizumab may improve results and decrease complications.